Key result
High Brugada risk score linked to ~5.1-fold higher post-ICD life-threatening arrhythmic events.
Why the study?
Due to the time-dependent expressivity of Brugada syndrome, the performance of current guideline clinical risk factors and genetic substrate in predicting arrhythmic events after ICD implantation remained unknown.
Does the Brugada syndrome 5-year risk score combining clinical and genetic variables and clinical practice guideline indications accurately predict life-threatening arrhythmic events after ICD implantation in patients with Brugada syndrome?
Cohort (n=551)
No
Does the Brugada syndrome 5-year risk score combining clinical and genetic variables and clinical practice guideline indications accurately predict life-threatening arrhythmic events after ICD implantation in patients with Brugada syndrome?
Hazard Ratio: 5.12 (95% CI 2.77–9.46)
p-value: p=<0.0001
In Brugada syndrome patients receiving an ICD, those with ESC class IIa indications (spontaneous type 1 ECG and syncope) have similar long-term arrhythmic event rates to secondary prevention (class I) patients, and integrating clinical and genetic factors via the BrS 5-year risk score improves the identification of primary prevention candidates who will benefit from ICD implantation.
May aid post-ICD risk assessment in Brugada syndrome; extends the 5-year score with genetic factors but leaves open prospective validation.
Aims Various clinical risk factors impact the natural history of Brugada syndrome (BrS) and establish the basis of current clinical practice guidelines (CPG) indications for implantable cardioverter-defibrillator (ICD). Due to the time-dependent expressivity of BrS, their performance in predicting the actual occurrence of arrhythmic events after ICD implantation remains unknown. Objectives To assess the occurrence of arrhythmic events based on the CPG indications and whether the genetic substrate can add to the prediction of arrhythmic events at follow-up. Methods and results We enrolled consecutive patients who underwent ICD implant either for primary or secondary prevention. Prospective clinical data included arrhythmic history, electrocardiographic findings, therapies, SCN5A gene mutations, and genotyping of three BrS-associated single nucleotide variants. Eleven per cent of 551 patients experienced life-threatening arrhythmic events (LAE) over a median follow-up of 8.1 years. Patients with ESC class IIA indication had a similar risk profile as those implanted for secondary prevention. The recently developed BrS 5-year risk score, including clinical and genetic variables, was a determinant of outcome in the whole cohort and in patients implanted for primary prevention: 26.93 ± 3.33 vs. 4.41 ± 0.61 and 11.67 ± 1.52 vs. 5.36 ± 0.99 in patients with LAEs compared with those without events (P < 0.0001). Conclusion CPG class IIa and I had a similar rate of ICD shock at follow-up. We also provide robust evidence indicating that the quantification of the BrS arrhythmic risk score at the moment of ICD implant may improve the identification of patients who will benefit from ICD at follow-up.
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Napolitano et al. (2026) conducted a cohort in Brugada syndrome following ICD implantation (n=551). High Brugada syndrome 5-year risk score (Q3/Q4, >9%) vs. Low Brugada syndrome 5-year risk score (Q1/Q2, <=9%) was evaluated on Life-threatening arrhythmic events (appropriate ICD shock and death during follow-up) (HR 5.12, 95% CI 2.77-9.46, p=<0.0001). High Brugada syndrome 5-year risk score and clinical guideline class I/IIa indications strongly predicted life-threatening arrhythmic events after ICD implant (HR 5.12, P<0.0001).
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